No office rate
50970 describes diagnostic ureteroscopy without biopsy. Choose 50974 when tissue is sampled during the examination.
On this page
CMS RVU26D · Effective 2026-10-01
50974 Ureteroscopy Medicare reimbursement rates in Illinois
Reports endoscopic inspection of the ureter with tissue sampling, commonly to evaluate a suspicious urothelial lesion or other abnormal ureteral tissue. Compare 50974 office and facility rates across CMS payment localities in Illinois.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 50974 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$428.45–$465.72
4 of 4 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 50974 pays more and less in Illinois
Urology endoscopy
About 50974: Ureteroscopic biopsy through cystoscopy
Reports endoscopic inspection of the ureter with tissue sampling, commonly to evaluate a suspicious urothelial lesion or other abnormal ureteral tissue.
A urologist passes an endoscope through the bladder into the ureter, inspects the ureteral lining, and obtains tissue for examination. The service is used when imaging or clinical findings raise concern for a ureteral lesion, including possible upper urinary tract malignancy. It is generally performed in an operating or procedure setting, with the sampled site and tissue submitted for pathologic evaluation.
Report this code when ureteroscopy includes biopsy; inspection alone or catheter placement alone describes a different service. The operative note should identify the side, the ureteral site examined, the abnormality sampled, and the biopsy performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. For a bilateral procedure, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 50974
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.93 · 72%
- Practice expense (office) RVU2.30 · 19%
- Malpractice RVU1.15 · 9%
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
50974 compared with similar codes
Office rates for Illinois, from the same CMS release.
No office rate
50972 includes ureteral catheter placement; 50974 is the biopsy service. The operative note should support the service actually performed.
No office rate
50976 represents ureteroscopy with treatment, while 50974 represents ureteroscopy with tissue sampling. Distinguish biopsy from therapeutic work in the operative record.
Compare 50974 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
4 of 4 payment localities
Chicago →
Office / nonfacility
Unavailable
Facility
$465.72
East St. Louis →
Office / nonfacility
Unavailable
Facility
$446.31
Rest Of Illinois →
Office / nonfacility
Unavailable
Facility
$428.45
Suburban Chicago →
Office / nonfacility
Unavailable
Facility
$447.32
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50974 billing questions
When should 50974 be chosen over diagnostic ureteroscopy?
Use 50974 when the ureteroscopic examination includes tissue sampling. Diagnostic ureteroscopy without biopsy is represented by 50970.
Is biopsy included in the procedure?
Yes. The tissue sampling performed during ureteroscopy is part of 50974; do not report the biopsy as a separate procedure.
How should bilateral ureteroscopic biopsies be reported?
For a bilateral procedure, report modifier 50. CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted under the CMS rules supplied for this code.
What documentation supports reporting 50974?
Document the ureteroscopic examination, laterality and site, the abnormal tissue or lesion, and that tissue was obtained for biopsy.
What happens when another related endoscopy is performed in the same session?
CMS applies endoscopy-family pricing when related endoscopies are performed together. The operative documentation should identify each service performed.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,00950961,,Ureter endoscopy & treatment,A,,5.89,5.48,,1.71,,0.76,12.13,8.36,0,000,0.00,0.00,0.00,3,1,0,0,0,9,50951,33.4009,09,0,99,0.00,0.00,0.00
6,01050970,,Ureter endoscopy,A,,6.95,1.88,NA,1.88,,0.90,9.73,9.73,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,01150972,,Ureter endoscopy & catheter,A,,6.71,1.83,NA,1.83,,0.87,9.41,9.41,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,01250974,,Ureter endoscopy & biopsy,A,,8.93,2.30,NA,2.30,,1.15,12.38,12.38,0,000,0.00,0.00,0.00,3,1,0,0,0,9,50970,33.4009,09,0,99,0.00,0.00,0.00
6,01350976,,Ureter endoscopy & treatment,A,,8.80,2.27,NA,2.27,,1.14,12.21,12.21,0,000,0.00,0.00,0.00,3,1,0,0,0,9,50970,33.4009,09,0,99,0.00,0.00,0.00
6,01450980,,Ureter endoscopy & treatment,A,,6.67,1.82,NA,1.82,,0.86,9.35,9.35,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,0155100F,,Rsk fx ref w/n 24 hrs xray,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00